Pioneer ACOs

"There's always a wave of early adopters," Robert Williams, national medical director at Deloitte Life Sciences-Healthcare Consulting, based in McLean, Va., told FierceHealthcare in an interview.

"You see larger health systems that have a large operating margin tend to be able to invest early on," Williams noted. Some organizations might be driven by local marketplace or their leadership is focused physician engagement. "Those drivers have positioned leaders to make a decision and move forward earlier than others."

For the early adopters of the coordinated care model, the Pioneer ACO program offers the 32 collaboratives an adjusted Shared Savings for higher payments, while they assume higher risk.

Unlike the Shared Savings Program, starting in year three of the initiative, those organizations that have earned savings during the first two years will be eligible to move to a population-based payment arrangement and full risk-arrangement that can continue through an optional fourth and fifth year.

CMMI released the list in December 2011, and the 32 ACOs officially launched Jan. 1, 2012. CMS closed applications for the Pioneer program.